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[PERMIT EXPIRES
US E
ZONE 95 P
ERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
ADDRESS
OWNER NAMIUKA E OF BUSINESS
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MAILING ADDRESS '�D FEE I
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CITY ZIP EXISTING - PROPOSED- es',
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NAME METER SIZE I LINE SIZE I NO. 01 IIXTUREI I REQUIRED
BE 0 No C3
ADDRESS REMARKS
OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
I.,
ITELEIHONE
NAME
!;,^4.6� IhC 0FCi5A-UZC— 40A
REVtEWEDIDATE
X ADDRESS
0 9 2,16' POPLAA PL, SHOL"T'll
FIRE REVIEWED By DATE
—11-02--
CITY ZIP TELEPHONE '7. 0 6
S Ci -rn. 6 W A '3-2—q 2_0!�a
STATE LICENSE NUMBER 7 Tl�
5M e IIVSW) DJ3
CHECKED By
VAIIANCE61 OU
SHORELINE Oil ADII
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;R P1`IUPERTY TAX ACCOUNT PARCEL NO.
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[PARKING
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED , PROPOSED
NIS
F W 0 PLUMBING MECH
E3 ADDITION C MPLIANCE OR
C14ANGE OF USE
REMODEL 171 SIGN
REPAIR [3 GRADING CYDS [:] FENCE
I X FT)
[j DEMOLISH [3 TANK
o GARAGE RETAINING WALL
CARPORT ROCKERY RENEWAL
..V.-
LOT COVERAGE
ALL Lo E E
OW 0 PROPOSED
PROP.-ED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr)
FRONT URSIDE REAR
REQ`D
I PROVIDED
LOT AREA
I PLANNING FIE1.11) BY DAI E
REMARKS
AE11 OR
OF USE, ByUlINESS OR IVITY) EXPLAIN:
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CHECKED BY
TYPE 01 CONSTRUCTION
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GROUP
NUMBER
OF
STORIES
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CRITICAL L
AREAS
NUMBER
SPECIAL INSPECTOR JAREA
R EQUIRED [] YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
I1V5?A1,lLA—no._V
REMARKS
P OGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
P-6 A b+a4 4 6-16 AA
VALUATION
— SOUND. ._dV.
LOT SLOPE
Building
VE,
PLAN CHECK STID DATE
Plu mbing
Mechanical
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THIS PERMIT AUTHORIZES ONILYTHE WORK NOTEM THIS PERMIT COVERSWORKTO
Ic BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
7
3 OINUM (CURBS, SIOMALKS,
2 0 DRIVEWAYS, MARQUEES, ETC., MU REQUIRE
Engr. Review
SEPARATEPERMISSIOW
MIYAPPLICATION: IS00AYS
Engr. Inspection
PERMIT LIMIT I YEAPR- PROVI ED WORK IS STARTED WITHIN I Be DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-PLIOW. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND 1UCCESO11
Traffic Mitigation
IN INTER al AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY 01
Fire Review
EDMOND:, WASHINGTON. ITS 0 FFICMLS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF 14NTEVER NATURE. ARIS NO DIRECTLY OR INDIRECTLY
Fire Inspection
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Landscapainsp.
I
I HERESY ACKNOWLE BE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZE AGENT OF
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
1
5 E (OrA 0 A`j;L I DATE SIGNED
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(425)
4H /IX— 13 - 1, -2--0 2-
ar
771-0220
11SIt ENTION
EXT 1333
OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPRWAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
40101
FEE
Recording Fee
City Surcharge 6-
State Surcharge
Plan Chk Deposit
Receipt #
Tota(AmountDue 14�5
Receipt #
APPLICATION APPROVAL
This application isnotopermn-il signed by the
Ji,g OfficiM or horlher Deputy: and Fee. are paid. and
/ DATa'
M`4�� , ) -
ORIGINAL - FILE YELLOW - INSfECTdR
PINK -OWNER - GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .............
FOUNDATION:
Footing ................
wall .............
Pier/Porch ...............
0
Retaining Wall
Slab Insulation ..........
-4
PLUMBING:
x
M
Underground
0
0
Rough -in ... ................
C
Commercial Final
M
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HEATING:
E:
GasTest ..............
Gas Piping ...............
Equipment..............
0,n
MITI,
Commercial Final
EXTERIOR SHEATHING
0
C §
NAILING .. ........................
C (z) I
Q 0
FRAMING ........................
FIRST FLOOR FRAMING
;U
INSULATION ...................
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Floor Insulation
Wall Insulation
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Ceiling insulation
0
SHEETROCK NAILING
M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY
...............